Were you by any chance once a speech writer for Blair (Tony, not Ian)?

You have a lovely line in feel-good vacuousness.

“I’m a little bit tired. I’m a little bit tired of arguing about why equality is important. Why human rights matter. Why poverty is not ok.”

I hope the self-righteous tone isn’t going to continue forever on this blog.

Who on the right disagrees that human rights matter?
In the UK it is Labour who is attacking on this front – the other parties are resisting, though perhaps not enough.
Who believes that poverty is “ok”?
Certainly there are disagreements about equality – but it is not dishonourable to believe that there is a tension between targetting equality on the one hand, and eliminating poverty on the other.

“What I need is a safer space where I don’t lose so much energy justifying why social and environmental justice are worth spending a lot of society’s money on.”

Society’s money? You mean individuals’ money.
So, no debate then? No place for the market to help achieve these ends? Case (and minds) closed?

I hope not.

Best

chrisc

nope, not been a speech writer for Blair

the Conservatives have regularly discussed how they would like to ‘scrap’ the human rights act, with Cameron most recently announcing the same in his party conference speech. the issue is spun as ‘some people’s human rights matter more than others’ – and therefore some people’s human rights don’t matter – demonstrating a complete failure to understand the meaning of human rights.

i’m interested in your point on the tension between equality and eliminating poverty, can you say more on that?

the market does not exist outside society. society’s money is individual’s money obviously, but so too is it companies’ money etc. you’ve narrowed ‘society’s money’ as being only about individuals; i’d expand it to mean many more of the economic resources available for our use, and not just as individuals.

The tension between equality and eliminating poverty is straightforward if redistributive measures hold back economic growth.
The tendency of the left to define poverty primarily in terms of inequality (people below x% of median or whatever) avoids that debate through sleight of hand, but the issue is surely worth discussing?!

Companies are owned directly or indirectly by individuals.
Taxing companies therefore taxes individuals – whether “fat cats” or lowly pension scheme investors.
All taxes are – ultimately – paid by individuals.

companies have money to spend outside of the taxes they pay. for example, they can choose what products to buy, what schemes to invest in, which research and development plans to pursue.

say more on the first point. if it’s worth discussing, start discussing it.

Chris, what proof do you have that redistributive measures do actually hold back economic growth, it’s hard to find conclusive proof of such things.

As for defining poverty in terms of inequality, it has to be done on those terms, the available resouces are simply too finite to suggest that we can all have empires.

I should rather say that an unnecessarily high tax burden holds back growth, not redistribution as such, which (depending on how it’s done) can be very beneficial for growth as well as for social cohesion.

Chris Dillow – a Liberal Conspirator – has this to say:

“I think this explains a lot about the demoralization of the traditional Left. They want more equality. But they cannot bring themselves to see that one way to achieve this would be to shrink the state and abolish the taxation of lower incomes. Instead, they carry on in the bone-headed notion that big government and equality must always go together.

If any political party wants my support – and they all seem determined not to get it – they would recognize that limited government and social justice are not necessarily enemies of each other. ”

see here

Very persausive.

Couple of points here, firstly in Chris D appears to have ommited National Insurance from the figures he quoted. In terms of income taxation, he omits national insurance, just a minor point but it’s worth pointing out that this is another signifigant section of what is essential income tax.

On the point of tax burden, whether money is spent privately or by the state it still continues to move round the economy. I can point out here that there are plenty of countries with a higher tax burden than the UK that still do well in terms of GDP growth.

The question here then goes to what services to cut to give the small government ideal. Many service cuts would require individuals to find private equivelants leaving any gains dependent on the relative merits of public vs private provision. Arguments here are probably best broken down into a specifics, but in most I tend to favour the public side of the toss.

I think you can make a very simple point that it would be better to raise the tax threshold to (say) 10k or 15k which would *at least* allow the whole tax credit fiasco to be dismantled.

Private (not necessarily for-profit) provision thrives in Scandinavia with respect to both health and education, with famously better outcomes.

And how could that not be the case?
You would not invent today’s NHS from scratch.
That “envy of the world” which (mysteriously) no-one else has attempted to imitate!
You would not (I assume) advocate a National Food Service?!!

You sound as if you want to debate foregone conclusions without having to argue the case for them. Further, you seem to presume your right to other peoples’ money – for there is no such thing as “society’s money” in truth – and spend it as you and your fellows have the audacity to think is the best way irrespective of the views of those from whom the monies were extracted. And no, a once-every-5-years shortlist of knaves each representing an all-or-nothing potpourri of “commitments” is not asking nor gaining permission!

How about just explain your case, stop taxing people quite so much and see what they do with their own money?

How about setting up voluntary groups to perform the functions you think are best and if the people support you they can do so with time and/or money?

You might say that they will be selfish and keep all the extra money they are no longer taxed. Your duty is then to reach out to each of them, not just lobby some sticky-fingered parasite who is arbiter over the pot and will want their mates employed to “administer” the beneficence via some overstuffed qango.

If you say people will not listen even after your sincere representations, then you are basically saying the population are selfish or stupid and only you and yours “know best” and as such must step in “for the common good”. That is arrogance. Surely you don’t mean that?

The only way to ensure nobody is left behind is to never move in the first place. This seems to be the net result of Leftist doctrine. No, I withdraw that – the net result is often that many are dragged backwards.

Thus, I would suggest the best way to REDUCE people being left behind is to not prevent them from keeping up or catching up. Rule of Law, minimal State interference and low, flat taxation are good starting points.

If you want an environment where you can freely associate and take action to help those you wish to help using money freely donated by individuals who believe in what you are doing, then join the Libertarian movement.

Chris C: The relativistic (aka inequality) measurement of poverty guarantees that it will always be with us. The whole notion that you can somehow “lift” people out of poverty if measured relatively demonstrates a woefull grasp of basic mathematics. (Lift someone out of the bottom 25% and by definition someone else drops into their place, anything else is a mathematical impossibility). By that measure even if the minimum wage were set at £5,000 per hour from tomorrow, there would still be a bottom 25% (Because as many people as today would still earn more than the mimimum wage) and there would still be relative “poverty”.
If you are going to have economic equality, as in doctors get paid the same as cleaners, then you need the full on, heavy duty, soviet economic model, not just cultural socialism lite bolted onto state sponsored capitalism……… .

Well, can I make a suggestion? Tax the super rich at the same marginal rate of taxation that people like you and I pay. Use that money to gradually increase the tax threshold for the lower paid. Worry not at all if these folk leave the UK, for they contribute nothing much to the common weal. Encourage them to take their tax avoidance lawyers with them.

Zohra. Is this the direction you want this thread to progress? Because, frankly, this is now a discussion about the relative merits of libertarianism or collectivism.

Chris – I’m not sure, I fear that the media distorts our perception of the NHS, there will always be a given number of column inches to fill. There will also always be enough health horror stories to fill them in a country the size of the UK.

As far as more impartial studies go, this one certainly shows the NHS in a good light, although I’m sure there are other studies out there. I’ve not seen any studies on Scandinavia vs the UK I couldn’t comment on the famously better outcomes or not. But I’d need more conclusive proof and comparisons showing the NHS is broke and there’s a good way to fix it before I advocate it.

I think that any privately funded system will involve an insurance system, and that any insurance system will involve the extra cost of administering it. I don’t see how the supposed marginal gains in productivity of the private sector handling healthcare will cover that extra cost.

Food is not a natural monopoly, healthcare is.

Roger – Why exactly should we risk the stable society we have for some quasi-utopian ideals with not a jot of proof that it actually works.

Andreas Paterson.

Surely the simplest way to progress this sort of arguement is to see what countries have the best outcomes in terms of health for everyone in their population?

If we use that as a criteria, I understand that France and Italy sytand head and shoulders above the UK, which, in turn stands head and shoulders above the USA.

If we are going to look at best practice, perhaps we should look at what the French and the Italians do.

I don’t think health is a “natural monopoly”.

If it is can you explain why it is only in the UK that it is run as such!!

PS – the UK is 17th out of 29 European countries in terms of healthcare outcomes.

We are behind Estonia!

“The survey looked at five areas of healthcare – waiting times for common treatments, results of treatment, access to medicines, patients’ rights and information, and “generosity of the system”. Britain scored well on patients’ rights, but poorly everywhere else.”

http://www.guardian.co.uk/international/story/0,,2181427,00.html

chrisc,

Well, depending on your definition, there is also:

Canada
Cuba
France
Israel,

etc, etc.

I would think that you could even argue that there is no monopoly in the UK if you wanted to, it just depends on the definition, does it not?

Is France a centrally managed health monopoly?
I don’t believe so.

I believe Canada is also government pays but private sector provides.

I’ll grant you Cuba(!!) and know nothing of Israel.

Of course there is no monopoly in the UK, since we have BUPA etc.

But I think the UK is alone in running its state funded health service as a centrally directed state run health sevice.

Profiles of 8 major country healthcare systems can be found here (bottom of page):

http://www.civitas.org.uk/nhs/orig.php

Andreas Paterson : Roger – Why exactly should we risk the stable society we have for some quasi-utopian ideals with not a jot of proof that it actually works.

What we have now and what is proposed in the OP is an Utopian ideal that has no proof of working – a Statist monopoly on “charity”, i.e. contribute under threat of imprisonment. Flat tax DOES work and works very well at getting the rich to pay the same rates as the poor and to avoid the wasteful practice of tax accountancy. I think most people, if freed from the chains of Welfarism and Statism, will again be generous, philanthropic and self-reliant. My proof? People always were! The problem was not a lack of desire to help, but the system used to harness it.

It is not “utopian” to have people decide what “good causes” get THEIR money. It is basically totalitarianism to demand people pay for the “good causes” that a group of self-appointed sorts decide are deserving.

We see every day the waste, the demoralisation and crushing of people sucked into dependency in pursuit of the prevailing social experiment of Welfarism. The CPA being a prime example – those already under strain being asked to go cap in hand for their own money back. Outrageous.

The question should have been why did we risk the stable society we had for some quasi-utopian idealism (Welfarism) with not a jot of proof that it actually works?

The evidence against welfarism, state monopolies on subsidised housing, education and health are all to clear to see. Sweden has sorted education, Switzerland, France and Germany have sorted healthcare. Maybe the UK will solve housing, but I doubt it!

From the report on France:

“To a central planner the French system looks like a chaotic mess, but in reality the mess is a pragmatic blend of consumer choice, professional autonomy, central regulation and a government-backed guarantee for the poor which exceeds the NHS standard by far. Like the Belgians, the Dutch and the Germans, the French in their own way have discovered how to universalise the benefits of a competitive market. The NHS, by comparison, has universalised the drawbacks of public sector monopoly.”

“Britain scored well on patients’ rights, but poorly everywhere else.”

Hmm – maybe there’s a connection ? When accesing healthcare, the exercise of rights would be pretty low on my list of concerns, far below getting an appointment that suits, being given the most effective treatment, competent staff, a clean environment and edible food.

Beleive it or not I find it harder to make a doctors appointment now than I did in the 1980s under Thatcher, and she didn’t even believe in the NHS. The problem I think is that NHS priorities have been distorted by an over centralised target culture, and the tendency to allocate resources as a response to pressure group/media/popular opinion rather than clinical need.

for CPA read Tax Credits.

ChrisC,

My point is simply this. I do believe in universal health care. I think it is a good thing. I think that looking at societies that successfully achieve that, better than we do, would be a useful jumping off point. Personally, I do not care whether the mechanism is statist or private, as long as it is demonstrably better, and universal. IIRC we were in the mid teens of outcomes, France was first and Italy was second. The USA was around 37th or so.

And I do not believe for one moment that Roger Thornhill’s non system would achieve anything equitable whatsoever. Perhaps he can prove me wrong.

We’re on the same page!

The difficulty is that too many people believe – exactly why I’m not sure – that the NHS is somehow the only way to provide universal healthcare, when in fact we are just about the only country to do it in that particular way. And the outcomes are not very good.

Why people refuse to look at France or Italy and learn from them, I have no idea.

Not even the Tories now dare propose such a thing!!

ChrisC, on the NHS the article you mention quotes that the healthcare systems either follow a “Bismark” (social insurance) and “Beveridge” (state funded) style systems. The first “Beveridge” style healthcare system in the list is Sweden (6th place). I how you can say that the NHS is not a model copied elswhere unless you are implying that the NHS is fundamentally different to other state funded healthcare systems.

However, this study does suggest that adopting a social insurance model might be the way to go. However, it’s still contradicted by the commonwealth fund study which puts state funded Britain ahead of social insurance Germany. A little more detail is in order for both studies I feel.

douglas clark: And I do not believe for one moment that Roger Thornhill’s non system would achieve anything equitable whatsoever. Perhaps he can prove me wrong.

No surprise, because I was not putting forward a “non system”. Swiss healthcare is certainly not a “non system”. Swedish education is certainly not a “non system”.

Roger,

Well, tell us all about Swiss Healthcare then. Is it universal? Does it have better outcomes than the NHS? Or perhaps, more importantly, does it have better outcomes than Italy or France?

I’ve told you what I think we should be doing, and that is in no way tied to ideology.

Douglas,

The Swiss healthcare system is State regulated (mostly at Canton level) but privately run via a plurality of insurance companies.

The state defines a minimum cover that providers must offer as a base. This has been described as “excellent” and comparable to a very good private scheme in Germany or the US, i.e. only something we in the UK could dream of.

The companies must offer the same price to all (but can compete on price between each other)

The companies cannot refuse cover to people (e.g. old, chronic)

People are free to change provider after 6 months.

People can top up cover as and when they wish either via on-off payments or additional packages.

Outcomes are very good indeed – IIRC they would be 2nd globally if you took out the WTO bias towards “distribution” which favours centrally tax-funded schemes – even the WTO admits it puts significant and disproportionate weight on its “distribution” metric.

The State is there regulating, but is not involved in provision. It appears to be arranged so people are protected and a form of redistribution goes on due to the need for providers to take all comers (i.e. risk is spread amongst a very large pool)

No system is perfect. The NHS is systemically dysfunctional.

oh, and the truly destitute have their policy paid for.

Roger,

Sounds good to me. We should look into it in depth. And, yes, that is a system. Meanwhile, we should continue with what we have, whilst possibly advocating what the Swiss have, or the French. But certainly not what the Americans have. Which is twice as dysfunctional as the NHS, at least according to the stats.

There are interesting State interventions in the model that the Swiss have, for instance the forcing nature of the contract between the provider and the citizen and the safety net aspect.

Already we have a discussion about universal health care.
Without getting niggly about Switzerland, or wherever…

A humane society is one that cares for all of it’s members, unquestioningly. If you think healthcare should not be provided -FREE- for all members of society, you’re not a liberal, you’re a git.

Next subject, please.

discoriggall,

Rule one. There ain’t nothing for FREE. Next please!

“Rule one. There ain’t nothing for FREE”

Course not. But it should be based on need and not ability to pay

The NHS is proberbly the only area where “from each according to his need to each according to his ability” really has worked.

LOL 😀

Scratch that

Reverse it 😀

The traditional left wing response about the NHS is that “without us you wouldn’t have it” which is true but that’s not the issue anymore. Everybody wants to keep the NHS. There has only briefly been suggestions by the tories of making it idenpendent.
What the left must realise is that the NHS is not effective enough per pound spent on it. Yes, tax should pay for it. However, the amount of tax spent on it has failed to produce the differences that it should have. The tories blame targets and top down government. In some cases that’s true. However, the far bigger, more common problem, which is more to do with the NHS culture, is inefficiency and money going to waste.

left of centre ground,

Yup, I agree that it was Labour what did it. And, frankly, at the time it was created it was indeed the greatest thing since sliced bread.

But, treating it as a sacred cow is frankly ludicrous. If, and only if, research shows that there are better Health outcomes under another system, more bang for your buck if you like, then we should be looking at that, should we not? We are not simply tick tock men and women in some sort of Stalinist collective. We presumeably want the best possible outcome for both ourselves, our loved ones and society as a whole. Independent of political baggage.

I, for one, would not compromise an inch on the universal nature of the provision. And the likeliest comparators are other Western European democracies, although we should keep an open mind on that.

Comstock – LOL

left of centre ground – I’m a fairly regular visitor to my local hospital’s opthalmology department, I have to say that from my observations the staff there are always busy and always working hard. I’ve heard the odd horror story, but mostly the NHS works quite efficiently. We spend about $2546 per capita compared with $3005 per capita in Germany and $3159 per capita in France (source). The NHS is not really any less efficient than most of it’s foreign counterparts.

Roger Thornhill (in response to #20) – I find the idea that if people are freed from statism people will choose to be generous, philanthropic and self-reliant absurd.Not just as a cynical observation on human nature but also on the basis that it assumes perfect information. Even if we assume that people will be generous and good natured, they will only act charitably for causes that they know about.

We may “see every day the waste, the demoralization and crushing of people sucked into dependency in pursuit of the prevailing social experiment of Welfarism” but what we see, we generally get from the media. And the media does not provide an accurate portrayal of the real world.

As to the question of risking the stable society we had for the quasi-utopian ideals of Welfarism. When did we embark on this experiment? Were things better before? I can’t work out where in history you’re referring to.

Well, free at point of access maybe. Society as a whole can foot the bill.

Certainly, with widening inequality, some people at least can afford to contribute more. Should be made to contribute more.

If Roger’s facts about Switzerland are accurate, then the service there is free at the point of access. It is an interesting question whether the contrbutions should be flat rate or scaled to earnings, but that seems to me to be beside the point. Is there a better way of running a Health Service than the way we run ours and, if so, would it be scalable and adaptable to the UK?

We already see the difficulty of such comparisons when we look at Andreas Pattersons’ figures. We are not seeing equal inputs and different outcomes. In a simple world you’d expect higher expenditure to result in better results, would you not? And that seems to be the case here.

What I’d suggest is that the first stage of this is to argue for funding of large scale comparative studies, unless someone is aware of these studies having already been undertaken.

Andreas – you are confusing funding with provision.

I am amazed that people (especially on the so-called left) would rather stick with the supposed ideological purity of the current NHS structure than have an open-minded look at what other countries in Europe are doing, and why their outcomes seem to be so much better.

When others – yes, often on the s-called right – raise this point they are shouted down and accused of wanting an “American-style” system.
Hell, even the Tories have given up proposing any meaningful reforms.

Not American-style, but how about a French-style system, or a Swiss-style system?
Those are the outcomes we should be aiming at, and the past five years have proved that throwing money at a monolithic state bureaucracy will not achieve them.

but if we privatise any part of the NHS how do we stop it going the way of the rail system?

I’m all for reforms too, but I can’t see how privatisation has benefited any service which doesn’t have any real competitors.

chem_fem,

I think that it all depends on what your motivation is, does it not? IIRC the conservatives’ privatisation of the Railways was rushed through at the end of a Parliament with no real forethought, other than the ideological driver that the state shouldn’t be running the trains. The outcome I would agree, is poor. Much as you’d expect from any ideologically motivated steamroller. If you want to see decent, no excellent, public transport, just look at France. How did they do it?

What I’m advocating is looking at best practice in service provision from wherever it comes from. And then thinking about it. And then, maybe, doing something about it.

On a broader note, the Westminster village seems to only respect comparators when they come from the USA. Which, when you think about, it is really comparing apples with oranges, most of the time.

The problem with the NHS is not the structure of the orgamisation, which has been messed about with dozens of times by various governments since its inception, nor the staff, who are generally competent and motivated. The problem is the “free at the point of use” concept. It served a purpose at the inception of the organisatrion when the aims and scope of the NHS were far less ambitious, and medicine was less complex and expensive, but it now gurantanees than no one, not the patients, not the doctors, not the managers, know or care how much anything costs. The result is huge inefficiency and waste. No one owns the money, no one pays for anything, so no one cares. This is why the NHS’s output seems to have almost no correlation with the input, and why no amount of public money will make a significant difference.
We can still have universal healthcare, but the system needs to be changed such that the costs are visible. This might mean charging at the point of use (as in the French system where costs are then reclaimed from public or private insurance) or it might mean some other mechanism, but the pay at the point of use concept is the holy cow which must be sacrificed if there is to be any progress.

“I’m all for reforms too, but I can’t see how privatisation has benefited any service which doesn’t have any real competitors.”

Stand back for a minute from your PC, look around at the connection at the back, that inter-web thingy box, consider who would have owned that connection 15 years ago at the dawn of the internet age, and ask yourself if you’d likely to have seen a 2Gb Broadband connection today if the same owners had still been a government monopoly.

HE did say in a sector where there was a natural monopoly. (Parts of) health provision is one. Railways is another. Broadband isn’t.

what Sunny said……
and there is no interweb-thingy round the back of my wireless Mac.
I was also under the impression that we are still behind France as far as internet availability and use went…

thanks

Exactly which parts of health provision are a natural monopolies?

Why does no other European country manage its health service in the same way?

Exactly which parts of health provision are a natural monopolies?

The parts that have to invest amounts of money to build world-class cancer / AIDS treatment centres and do research.

“and there is no interweb-thingy round the back of my wireless Mac.”

Yes there is.

“I was also under the impression that we are still behind France as far as internet availability and use went”

I fail to see what has to do with the original argument, the French telecommunications industry was eventually privatised some years ago. Are you saying we would actually be better off with a government telecommunications industry, or France benefitted by having their telecommunications under public control for longer ?

“HE did say in a sector where there was a natural monopoly. (Parts of) health provision is one. Railways is another. Broadband isn’t.”

I disagree.Telephone wire and exchange ownership in this country is still largely controlled by BT, that is synonymous with railways. The public control of railways or telephone lines is what creates the “natural monopoly”. After privatisation both telecommunications and railway networks were augmented by privately financed extensions.

“but the pay at the point of use concept is the holy cow which must be sacrificed if there is to be any progress.”

Not necessarily, bringing NI payments in line with all other health insurance premiums might be slightly beneficial, use an assessment of lifestyle/risk and demand higher payments from those who deliberately damage their health. The effect may be similar to knowing smoking is going to triple or quadruple your life insurance, or perhaps getting points on a driving licence is going to increase your car insurance, it might work, you never know.

“I’m a little bit tired. I’m a little bit tired of arguing about why equality is important. Why human rights matter. Why poverty is not ok”

I’m sorry – do many people argue with you about why poverty is okay? or why equality isn’t important or why human rights dont matter? who the heck have you been hanging around with?

I can see a problem with that. Aside from the never ending arguments about what constitutes “deliberately” (Smoking, eating kebabs, going mountain biking, I do all of them and they could all put me in hospital) – the fact is the least healthy also tend to be the least wealthy, and would be unable/unwilling to pay higher premiums, what may result is an NHS that only treated healthy people.

After privatisation both telecommunications and railway networks were augmented by privately financed extensions.

Well the telecommunications sector is different in that many other related companies with financial muscle came in because of convergence (BSkyB, NTL/Telewest, ISPs etc). It’s not so easy in the health sector. And look how the railways turned out.

“I’m sorry – do many people argue with you about why poverty is okay? or why equality isn’t important or why human rights dont matter? who the heck have you been hanging around with?”

Arguing in favour of poverty, you may have a point, but there are a great many people who’d argue that equality isn’t important, or even is necessary, and human rights don’t matter, most of them from a religious perspective.

“Well the telecommunications sector is different in that many other related companies with financial muscle came in because of convergence (BSkyB, NTL/Telewest, ISPs etc).”

BSkyB originated in satellite transmissions, not telecoms or broadband services. NTL/Telewest are who I talk of, they implemented their own separate networks, only possible because of privatisation, the same was done of the railways, for example; the DLR and Croydon Tramlink.

ISPs run off the back of telecoms, that is not direct competition.

I’m arguing that telecommunications have benefited from privatisation, are you claiming that is not the case ?

Matt, how about the reverse, give people discounts on NI if they lead healthy lives, perhaps a “no claims” discount ? Alternatively, scrap the fags n booze tax and replace with 3x/4x NI.

-“and there is no interweb-thingy round the back of my wireless Mac.”
Yes there is.

No there is no connection round the back of it, it’s all neatly packed inside the laptop. If I was to turn it round I’d see nothing, but that genuinely has nothing to do with the argument.

-I fail to see what has to do with the original argument, the French telecommunications industry was eventually privatised some years ago. Are you saying we would actually be better off with a government telecommunications industry, or France benefitted by having their telecommunications under public control for longer ?

I’m saying that either way they still have a system that’s better than ours even in an industry that (unlike the railway system) has had much more competition in the uk over the years, at least where it comes to the internet. Maybe what they are doing better than us isn’t actually related to whether a system is public or private.

I’m arguing that telecommunications have benefited from privatisation, are you claiming that is not the case ?

I’m saying telecommunications has benefitted (wonderfully) from privatisation precisely because its different to health and railways. I’m not against the market, but I’m not in favour of it unequivocally in all cases regardless of how the market it. There are natural monopolies, most economists recognise that. The point then is – what are the conditions which define those natural monpolies?

“No there is no connection round the back of it, it’s all neatly packed inside the laptop. If I was to turn it round I’d see nothing, ”

I bet that somewhere in your house will be a little box connected to the outside world, that is technically known as an “inter-web thingy box”. And just because you can’t see the wireless signals travelling between it and the Mac, doesn’t mean they are not there.

“but that genuinely has nothing to do with the argument.”

Precisely.

“what are the conditions which define those natural monopolies?”

Regarding railways, water, gas, electricity and telecoms, there is a physical infrastructure that defines the monopoly. So in that sense I see no difference between them. The infrastructure can be extended through private funding, which is what privatisation essentially allows.

You can separate the service from the infrastructure, but that is different. In the case of BT, the LLU policy allowed private companies to take over exchanges as well as built new networks, so this was an area that benefited from it.

discoriggall: “A humane society is one that cares for all of it’s members, unquestioningly. If you think healthcare should not be provided -FREE- for all members of society, you’re not a liberal, you’re a git.”

Ah, but that is NOT what you are suggesting. A humane society could be as you describe, but a State that decides§ people must be coerced with the threat of imprisonment to pay for a universal healthcare system is NOT liberal at all, but collectivist and authoritarian. This is why it took a Labour government to do it. Collectivists and Authoritarians are not Liberals, but are most certainly gits!

And at #39 “Society as a whole can foot the bill….Should be made to contribute more.”

How very generous of you…not.

Andreas Paterson (#38):

You find it absurd? How about now where people abdicate themselves from charitable acts due to the all-encompassing, Infantilising state? Yes, abdicate. To think people would not adjust themselves when they realise they cannot pass the buck to the State is the true absurdity, unless you think the effect is now terminal? I do not. A State is highly unlikely to have a better grip on the true needs of society than the people on the ground – even more so now with the Internet. Even if it did, which is, frankly, an impossibility, 70p in the £ is lost due to admin, waste and poor purchasing. Witness any grassroots voluntary organisation – they tend to do so much more of the right things in the right way and for pennies vs the clumsy, politically jaundiced State. What does the State want to do? “Embrace the Third Sector” – like some Python embracing a lamb. FYI welfarism has been a slow and steady process, with the biggest step in 1948. Before Welfarism we had Friendly Societies which were severely impacted by welfare legislation in 1911, a large network of Hospitals – you know, all those Nationalised in 1948?- and a mix of educational provision. You can always go back and attack how it was using the standards of today, but that is another absurdity. Just because things were far from perfect, does not mean a State monopoly funded by coercion is the answer.

Matt Munro #46,

I do think the problem with the NHS is its structure and the very fact provision is by the State. NICE was created to stop postcode lottery, so now we get bad decisions for the entire country. Tinker tinker. Answer is to stop forcing people into a monopoly so the bad providers die. Same goes for education, btw.

Sunny et al – “Natural Monopolies”

Healthcare is NOT a natural monopoly. You can go to various Hospitals, have a different GP. Sometimes different suppliers might use the same Hospital, but this is not always the case. In the Broadband analogy there IS a natural monopoly. It is called BT Wholesale. It is split from BT proper and it runs the wires between the subscribers and the exchanges. It also runs the exchanges and the ADSL modems. I am unsure if it also runs the IP backbones. It is a natural monopoly as if you wanted to change provider you would have to dig up the road and wire your house into some other network and each network would have to provide the possibility of last mile connection. Daft. Same goes for the “last mile” water, gas and sewerage. However, we have one setup with Gas and Electricity vs another for Water. Water is a Geographic Monopoly, so we are stuffed, I mean, stuck. Can you go to USwitch and get a better price for water? No. The very fact you can have “choose and book” shows that Healthcare is NOT a natural monopoly. Not by a very long way.

The very fact you can have “choose and book” shows that Healthcare is NOT a natural monopoly. Not by a very long way.

I didn’t say all provision of healthcare was a natural monopoly. I meant investment in big, expensive equipment and even research (big pharma for example usually only research stuff that brings them lots of return and focus much less on disease that affects developing countries for eg).

A humane society could be as you describe, but a State that decides§ people must be coerced with the threat of imprisonment to pay for a universal healthcare system is NOT liberal at all,

Well that means you’re against taxes full-stop. I’m afraid I don’t buy into that vision of anarcho-libertarianism.

Roger,

You advocated the Swiss system earlier in this thread. I am at a loss to see how compulsory insurance paid to a company is any less coercive than taxation. See here:

http://www.cnehealth.org/pubs/health_care_in_switzerland.pdf

Perhaps you can advise.

Sunny – why do you think the UK is the only European country to behave *as if* healthcare was a natural monopoly?

Why does no-one else want to go down the centrally directed monolith route?

Have they got it all wrong?!

Sunny: “Well that means you’re against taxes full-stop. I’m afraid I don’t buy into that vision of anarcho-libertarianism.”

No it does NOT mean I am against all taxes, Sunny, all it means is people cannot puff about saying that it is – and, by implication, they are – “Liberal” in the adoption of the solution.

Taxes are a necessary evil, a “least worst” solution to funding the core purpose of the State – to enable its citizens to go safely about their business without let or hindrance. Therefore, no, Sunny, you cannot dismiss the description by labelling it “anarcho-“. In the case of Healthcare, the Swiss system is not funded mostly by taxation, as people buy their own policies from a range of suppliers. There is a mechanism of risk pooling and yes, subsidy via some taxation, but we are compelled to insure our cars – is that “compulsion”? Yes. Is it pragmatic? Yes. Is it taxation? No.

Douglas, I hope my answer to Sunny, above, explains my position.

I addition to what Roger T explains, it should be noted that the “coercion” described by Douglas is not the real problem regarding tax or mandatory purchase of insurance.

The NI is a classic tax because it directly linked with ability to pay. The Swiss system is more open and related to individual personal risk, as it should be with all insurance. Tax and risk are vastly different aspects, for one thing, individual control is only applicable to risk, as liberals should this not be encouraged ?

It is probably expected that there should be an government underwritten guarantee to basic health insurance, but not to the extent that _all_ personal liability is accounted for and charged to others, as in the NHS, which is what makes it far from a liberal solution.

Ian,

You and I are clearly on different wavelengths here. Roger rails against coercive taxes but sees compulsory insurance as in some way different or better? For the sake of the discussion, imagine a completely privatised state if you will. In the stead of taxes we are simply forced to pay charges to service providers. From the consumers point of view, there is no substantive difference. It is simply Tax by another name.

You say the Swiss system is more open and related to individual risk. Could you point me to where that is said? As far as I can see it is a flat rate payment, independent of risk. Sure, you may be able to get the same level of cover cheaper from provider A rather than provider B, but, as both are required to take you on exactly the same terms and conditions as anyone else, there is no differentiation whatsoever, at least in the terms you describe. And you can ‘go private’ if you can afford it.

Correct me if I am wrong, using the example to hand. Y’know, the Swiss model.

Douglas,

Coercive taxes in this case are connected to a monopoly about which we have little or no choice who delivers what and when. Compulsory insurance at least allows choice, competition, innovation etc to occur naturally in the marketplace, with an eye on cartels. It is a least worst option, so my preference is just that – it is not as bad as the direct taxation model – the term “better” is a little misleading.

As for Switzerland, you are correct, the risk is pooled and the premiums from a particular provider are flat.

Roger,

Thanks for that. Given that I am attempting to argue that we should look at best outcomes as the measurement of choice, given similar inputs in terms of cash, do you think the Swiss system is better? As it is predicated to be the second best health system in the world, should we not be looking closely at it, from the point of view of adopting it? We languish in the mid teens in terms of outcomes, I think.

I think that funding, whether through taxes ot premiums, is a red herring, although I’m willing to be persuaded otherwise. What is it about the Swiss system, apart from the funding mechanism that makes it better? Does the method of funding allow more money to go directly to primary care, or what?

I have a genuinely open mind on this, and subject to what I said about best outcomes, I have no political baggage on this subject.

Just in case you wondered.

Douglas,

I do think the Swiss system is better and in part because it is not funded via taxes. Bear with me on this, for there is a good reason why.

If you have taxes you have a State run monopoly or, even worse, some Private monopoly or contract from the State. The State is an appalling purchaser. If it makes a mistake we all suffer. It is a slow learner and operates via the prism of political judgment. In a system where there is plurality of provision, people will abandon resources and providers that are substandard. Plurality also tends to create spare capacity, allowing people at least a chance to avoid the poor performers. This is why spare capacity is not “inefficient” for if a resource is so bad, it gets no patronage and it will either be shut down (no more waste) or it will improve and have to exceed the others to regain its position (also very good for advancing standards).

As to the ratios, that really is not the issue, for any provider that is not meeting expectations, another will see the gap and step in, attracting premiums. The system keeps itself running without any central control. That is the beauty of it, that is the efficiency and responsiveness – the Swiss system ranks really high on responsiveness to patient need (whereas the NHS is really poor at this) just as the big 5 supermarkets in the UK are highly responsive and some of the best in the world.

So the issue is not “x% on primary care” that you can then put into a plan and “make” the NHS or such perform in the same way. It will not work that way. It is also not about how much money goes where, but on how it is spent, who spends it, who works there, how they do their jobs and how they organise themselves. The most efficient mechanism to propagate this is to have multiple entities trying to out-do each other and for all to be open to adopt best practices as and when they suit local conditions or company structure. It also needs one group to be free to bid for the best personnel via higher wages. National pay scales for nurses, for example, even with London weighting, is not the way to go in my view. I’d like to see the best nurses paid much more, just as I’d like to see the best teachers paid more. With the unions involved treating it like one massive national employer, that is unlikely to happen.

What Roger Thornhill has said, I agree.

Roger,

Thanks for your thoughtful response.

You do indeed make a very good case. If the point of this site is to act as a sort of free form liberal think tank, then that idea should be on the list.

I know it’s early days, but embracing something which is not, on the face of it, what we are supposed to be saying or thinking, would certainly mark out some territory. A statement by any party that they were going to move the UK to second place in the world health care league would be so powerful, that they would likely get elected by acclamation!

Who’s job – on LC I mean – is it to pull stuff like this together?

Lets see,

Rigorous emotion, rigorous empathy, but no rigorous ethics?

Never fly!

BTW, Global warming is a diversion. Deal first with…..

[1] Epidemic CoalGen plants without clean coal tech. US and worldwide.

[2] Fossil smog enveloping cities…worldwide. [electric car][compressed air car].

TonyGuitar.blogspot.com

GW is a diversion. Forget cattle flatulence. A natural constant. = TG

Seems to be something wrong with the comments, mine got cut off, and douglas, some you had yesterday appearing to be missing?

Here’re mine again:

Roger Thornhill @10: Re ‘foregone conclusions’, please see response to rabbit below.

Re ‘presuming my right to other people’s money’ and the rest of that paragraph: you’ve proved my point about how I do indeed often have to spend energy justifying why social and environmental justice are worthy of financial investment.

By the way, who are my ‘fellows’?

Thom @55: Yes, there are people who believe that:

– Equality is not important: Tony Blair at one point tried to ensure that some organisations (namely Catholic-run adoption agencies) could be exempt from having to comply with equality legislation: http://news.independent.co.uk/uk/politics/article2171678.ece
– Human rights don’t matter: see comment #3
– Poverty is ok: the Government’s current policy on rejected asylum seekers forces them into abject poverty even though its own Home Affairs Committee noted that this is unacceptable as far back as 2004 (See http://www.amnesty.org.uk/content.asp?CategoryID=10682 – one of many research reports on destitution amongst asylum seekers)

rabbit @77: I spend my days talking to people who agree with me as well as to those that don’t. My post was about what kind of conversations I would like to have on Liberal Conspiracy. What I expect from that is a limited consensus around core principles (see above re equality, human rights and poverty, and also https://liberalconspiracy.org/2007/11/05/standing-up-for-liberal-left-ideals/ and https://liberalconspiracy.org/2007/11/05/its-time-to-take-on-the-right/ for more on this). Beyond that, I expect much discussion.

Roger Thornhill @ 75: could you provide some evidence on this claim please: ‘the big 5 supermarkets in the UK are highly responsive and some of the best in the world.’ Specifically, do you mean that they are highly responsive to consumers? And what do you mean by ‘best’? Here’s a bit on some of the pitfalls of supermarkets: http://www.foe.co.uk/resource/press_releases/20030113134910.html

douglas clark @77: it’s Sunny’s job I think, and it is part of the plan to develop LC positions as we generate ideas and build consensus on particular issues.

It’s worth noting that the “Swiss system” is just the “German system” working better in a smaller millieu. If we’re going to hold it up as an exemplar of what is possible, then why not use the example of the Danish system? Oh, that’s right, the Danish system looks a lot like the NHS system, so people don’t want to use it as a comparator, because it doesn’t suit their free-market ideologies.

zohra, er, in regard to “other peoples’ money” you did not prove any point whatsoever. You disagree, that is all. My points still stand.

“poverty is ok” – If they are rejected, they should leave, so the issue of their poverty in the UK should be non-existent. This is an issue of Rule of Law and to allow failed asylum seekers to remain is an insult both to the Rule of Law and to all those honest people who abide by our regulations when trying to migrate here.

As for the big 5, I am talking about UK supermarkets vs other supermarkets so the FoE moan in your link is not relevant to the point. A State-run food distribution mechanism like one would get in N Korea or the old Soviet countries is rather poor, don’t you think? It would be churlish to question that Tesco is one of the worlds best – logistics, responsiveness, range, quality – and that means all our other domestic retailers have to keep up. Sainsburys is better now, moving beyond their arrogance of the recent past, because Tesco was eating their lunch.

Metatone,

Or OTOH it might be because the Danish Health care system ranks 34th in the World, according to this:

http://www.photius.com/rankings/healthranks.html

It would hardly be ‘progressive’ to look at systems that are actually much worse than our own now, would it?

No doubt we are going to end up in a discussion about how accurate a reflection these comparisons actually are, and I am taking it on trust at the moment that there is actually a bias in favour of state provision. See Rogers Post at 29.

Outcomes are very good indeed – IIRC they would be 2nd globally if you took out the WTO bias towards “distribution” which favours centrally tax-funded schemes – even the WTO admits it puts significant and disproportionate weight on its “distribution” metric.

but at face value….

Metatone, the reason is because the Danish system is

1) Degrading. It is slipping in the rankings
2) Suffering “path dependency” due to its tax funded, geographically monopolistic (county-controlled) set up.
3) There is a growing private insurance market as a result of the increasing dissatisfaction in the system.
4) Denmark is also a small country – 5.4million people vs 7.5million in Switzerland – and still the State system is not as good, even with 32% local taxes to fund it (and still more from central income taxes).
5) Lack of innovation.

“Equality is not important: Tony Blair at one point tried to ensure that some organisations (namely Catholic-run adoption agencies) could be exempt from having to comply with equality legislation:”

Zohra

The particular “equality” legislation you are talking about was forcing all foster and adoptive parents to sign agreements to “promote” homosexuality. The left always turn such objections into a catholic thing, despite the fact that muslims also complained about being forced to promote something which conflicts with their beliefs and that, despite a shortage of carers, it seems more important to impose one particular version of equality at the expense of another (ie freedom of sexuality is more important than freedom of religion) even where it harms the neeeds of children.

Roger Thornhill:

If you’re going to pretend that 5.4 million people vs 7.5 million is a substantial difference, but then clam that 7.5 million country is a template for the UK population of 60 million, I think that there’s some incongruence there.

Roger @81:
We appear to be at cross-purposes on the money point. You are arguing the detail, and I am talking about having to make the case for welfarism more broadly. I’d suggest we move on.

The link I posted on asylum-seekers discusses why some of those whose claims have been refused are not able to leave the country as soon as their claims fail but you appear to have missed that very important aspect of the discussion. My point was not about *whether* they should leave, and neither was the report’s. The point is about those that have been unable to leave, and the conditions they are forced to live in until they are able to leave. To make it about the rule of law – and perhaps you could clarify what you mean by this? – is to profoundly misunderstand the reasons for why people get ‘stuck’ in the country and is also refusing to engage with my point which is that there are many people living in abject poverty as a result of a system that isn’t working and that is not ok.

Re supermarkets, please be constructive – the FoE report was not a ‘moan’. If you have issues about their research methodology, name them. I’m confused why you would assume a criticism of large supermarkets is a request for a ‘state-run food distribution mechanism’ especially when the report I was linking to is talking about the benefits of local food producers including farmers and small businesses. Thank you for clarifying what *you* mean by ‘best’ because that helps me understand why you would value Tesco when I wouldn’t. For example, the ‘responsiveness’ you praise is a result of a virtual monopoly (http://www.guardian.co.uk/comment/story/0,3604,873554,00.html) that allows Tesco to abuse suppliers until they submit – all in the name of being ‘responsive to consumers’.

Matt Munro @ 84:
I have to disagree. The equality legislation in question – which should not at all be in quotes – was the Sexual Orientation Regulations 2007. These regulations are about outlawing discrimination on the basis of sexual orientation in the provision of goods and services for those organisations that are solely or mainly commercial or that provide goods or services to the public. They are not about ‘promoting homosexuality’ as you term it and I reject the claim that treating a gay couple as you would treat a straight couple at a B&B is ‘promoting’ gayness (which was one of the worries). And they certainly make plenty of exceptions for religious organisations.

I have not seen anything that talks about how foster or adoptive parents would have to sign such agreements – do you have a reference on this? Everything I’ve read around the adoption row was about how Cardinal Cormac Murphy-O’Connor wrote to the Cabinet to say that Catholic agencies would close if the law said they could not refuse to place children with gay parents.

If religious groups or individuals don’t want to have to treat gay people as they would treat anybody else, they shouldn’t be delivering services to the public. The fact that a valuable service (e.g. the Catholic adoption agencies) would be lost is difficult, but I’d rather they close than be allowed to discriminate.

I don’t know who you mean by ‘the left’ when you say it was turned into ‘a catholic thing’ since the story I linked to was referring to Tony Blair (acting in his capacity as Prime Minister) and Ruth Kelly (the Minister for Equality at the time) – who are self-proclaimed Catholics and the story’s point was about how their religious (Catholic) beliefs were affecting their decisions on the equality legislation.

Roger @ 81: When you say ‘so the issue of their poverty in the UK should be non-existent’ you are doing what I’m concerned with: acting like poverty is ok. Because the fact is, their poverty is very much in existence, and there are many of them. So I’d like to spend my time on this site talking about how to deal with it – not having to make the point that it is real.

zohra, on poverty I do not deny it is “real” nor assert it is “ok” – where did I say such a thing? You are focusing on symptoms – I am talking about the disease (i.e. the broken system, not the asylum seekers!). There is little purpose dealing with the former if the latter is not getting priority. The issue of rule of law is, and I repeat, in what happens if you focus on the care of failed asylum seekers vs those trying to gain entry legally. First one deals with their poverty, then housing, then work then…well, why should they make any effort to return home now? I don’t blame them, mind. More fool us. That road is paved with good intentions. I want to fix the system, not construct a new bypass around it to hell. The more people know that if they fail that they will be cared for BY THE STATE (you are very welcome to fund care personally if you wish, btw…), the more we will get bogus, specious and undocumented applications. More traffickers, more suffering. More kids embedded in schools and so the plea goes about “human rights” and we will have more people bootstrapping themselves in while those being honest are in a queue.

Welfarism: I am not focusing on specifics re: welfarism. The very core is how money is moved and the systems and relationships – or lack thereof – between giver and receiver. And no, the State is not “giver”, it is a “taker”.

Supermarkets: maybe I was jumping without intermediate steps. in the long term you either control food distribution or not. You can try to control parts of it, but that rapidly gets deeper and deeper. What to do about Tesco? Tell people it is doing x and y. I do read this. I keep an eye on it, but I reject the implicit assertion that these private companies selling services to free people should be significantly controlled by the State. The dairy farmers need to protect themselves – their treatment is not good, but the State is doing more damage to them than Tesco ever could with its RIDICULOUS plans for pushing UHT milk! The dairy farmers should form a co-op (or better still a series of co-ops) and fight their corner. Give too much State protection to dairy farmers and we get a French style gravy train (cream cake?) of protectionism. Worse than what we have now, as the consumer is then forced to pay regardless of where they buy their milk – at least now we have a chance to attack and shame the big retailers, but once you get the diary farmers on the state teat, as it were, it will be hard to get them off.

So often it is not a choice between “right” and “wrong”, but “bloody awful” and “least worst”. State interference in food distribution and sales in terms of logistics, outlets, pricing or State subsidies and protectionism is in the “bloody awful” camp. Tesco is least worst in my view, least worst vs Statist intervention. To fight it, consumers need to voice out, shame etc. I did label FoE a moan – yes, maybe that was a bit harsh, but it did include that irritating “carbon footprint” baloney of air freighted veg – Kenyan tomatoes airlifted need lest energy than hothoused alternatives in Holland! They need to raise their game and stop propagating disingenuous memes.

Hi Roger
Thanks for this.

My concern was with this statement of yours: ’so the issue of their poverty in the UK should be non-existent’.

I don’t see it as either/or: I think you can worry about how asylum-seekers whose claims are rejected fare before they get back to their countries of origin at the same time that you consider how to make the system work better.

In fact, the idea that if we make sure they aren’t starving and forced to beg or prostitute themselves on the street (what you call having the state care for them) is going to encourage more ‘bogus’ applications is a common lement – where is the evidence that this happens?

This issue is also being picked up elsewhere on LC (https://liberalconspiracy.org/2007/11/12/how-can-we-be-different/), might be worth transfering our discussion there so we can move on from my post!

On supermarkets and this point: ‘You can try to control parts of it, but that rapidly gets deeper and deeper.’ I’m not convinced. We regulate all kinds of things without slipping into complete state control (e.g. food additives). In my opinion the usefulness of state intervention is about degree. Using words like ‘control’ misrepresents what I am suggesting. My point was about Tesco’s *abuse* of suppliers, you’ve then intimated that the only solution to this would be protectionism.

There is also plenty of evidence that if left to their own devices, supermarkets, including Tesco, would not choose a path of integrity. Here is a link to a story discussing how Tesco (amoung others) is pressuring the Soil Association to lower standards on its organic certification: http://www.guardian.co.uk/environment/2006/oct/05/food.organics.

And here is a really interesting story on the myths around ‘consumer choice’ and how leadership by the government could encourage supermarkets to take more responsibility for the ‘choice-editing’ they already do.

Oops, forgot link to second story, is here: http://lifeandhealth.guardian.co.uk/food/story/0,,2198617,00.html

Metatone: “If you’re going to pretend that 5.4 million people vs 7.5 million is a substantial difference, but then clam that 7.5 million country is a template for the UK population of 60 million, I think that there’s some incongruence there.”

No No No Metatone. Your response is non-sequitur.

YOU introduced Denmark as a good example of state healthcare provision. I and others point out it is not very good at all and it is even smaller that Switzerland and has some decentralisations that indicate that it would function better than the NHS would. Three factors and yet it falls short. The Danes are not stupid, feckless people – from what I gather it is systemically flawed, just as the NHS is.

Ma’am. you seem to be unfamiliar with the core of a democratic political society. Debate and discussion are the fuel for the fire of liberty. If you take those away, you don’t have an open political dialog, you just have an echo chamber.

Now, everyone thinks their political causes and policies are the correct ones. Your problem is the same one that statists on both the right and left have: that your beliefs and policies are not just the right ones, but that this assertion is beyond reproach and thus the question to be discussed is not “if”, but “when”.

You see, I fundamentally disagree with your methods. No one wants people to be poor, or for the environment to be polluted. I also happen to like keeping the money I earn and heating my home as well. Which means I question your methods, and not your goals. It’s somewhat nuanced, but I have no doubt that one of the wonderful, witty, intelligent people of the media will appreciate it.

Regarding rail monopoly. By its nature the railway may have a monopoly on the rail service between Glasgow & Edinburgh or wherever. But its not a monopoly in any other useful sense. Its competing with road and air transport (even water transport, over longer distances).

The road lobby have always been keen to stress the monopoly nature of rail with a certain faux piousness while pretending that road (or whatever) doesnt compete with rail.

Hello,

I’m not entirely sure what your problem is. As regards poverty, there is always something that can be done there, even if it is just “sparing some change”. Try looking into the Give As You Earn scheme as well.

As for “human rights”, I find that the definition of these varies from speaker to speaker. If you are talking about doing no harm to others, I think you are on the right track if you are thinking morally in the first place.

Good luck!